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Abnormal Psych Block 2 Exam Study Guide.docx

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PSY 322

Abnormal Psych- Block 2 Stress and Health - Why is it important to care about physical health? o The mind and the body have a connection in the following ways  Some psychological processes can produce physical conditions, illnesses  Some physical conditions have no biological basis  Some psychological processes reduce immune functioning and contribute to illness • A lot of cortisol is bad for immune function  Some behaviors can maintain or spread illnesses - Influence of stress o Historically, most cases of illness and death were related to injury or infection o Today, most cases are related to chronic health problems  Many of these conditions are influenced by stressful lifestyles o 1900s- infectious diseases like the following took up a large percentage of US deaths  Tuberculosis  Pneumonia  Diarrhea/enteritis o 2000- heart disease, cancer, strokes, and chronic lung disease take up the majority of US deaths  More lifestyle related - Stress is defined as the interaction between stressors (stimulus, demands placed on an organism) and the biological and psychological responses to demands o Stress is a byproduct of inappropriate coping o There is positive (eustress) and negative (distress)  an example of eustress would include having a baby - steps that lead from stressors to abnormal behaviors o awareness and appraisal  you realize that there is a stressor and that it poses a danger o coping  you may try to solve the problem constructively o stress  if coping fails you experience the unpleasant physiological and psychological aspects of stress o defense  to reduce stress you may use defense mechanisms, which can lead to abnormal behaviors o abnormal behaviors  psychological component • anxiety, depression  physiological components • headaches, muscle tension - Factors Predisposing a Person to Stress o Risk Factors  Negative interpretations of events  Poor coping skills/lack of resources  Particular form of the 5HT-TLPR gene • Increases risk of stress, depression, anxiety o Seratonin Transporter Disease  Early life stress • Increase likelihood for stress later on in life o Protective Factors  Optimism  Self-esteem  Social support - Characteristics that determine how serious a stressor is o Severity  Important aspects of one’s life tends to be more “severe” • for example death of a loved one o chronicity  how long it lasts • cancer for years versus one week of job training o timing  when it occurs  are there other stressors present • 4 exams in one week versus just 1 o Proximity  How closely does it affect your personal life • You lose job versus best friend losing their job o Expected?  Unpredictable and unanticipated = more stressful o Controllable  Is there anything you can do to reduce the impact? • For example start looking for a new job before you get let go - Stress Response o Sympathetic-adrenomedullary (SAM) system- Faster Acting  Hypothalamus stimulates SNS  Adrenal medulla secretes adrenaline and noradrenaline  Heart Rate Increases o Hypothalamic-Pituitary Adrenocortical (HPA) system- slower acting  Hypothalamus releases corticotrophin releasing hormone (CRH)  CRH stimulates pituitary gland, which secretes adrenocorticotropic hormone (ACTH)  Induces the adrenal cortex to produce stress hormones (cortisol)  *involved when having prolonged stress  *indirect to fight/flight pathway and release of cortisol!  *cortisol for long periods of time in the body can be very bad - The Immune System o There is a link between stress and suppression of the immune system  Wounds heal slower when stressed  Depression is associated with decreased immune functioning  Transition from HIV to AIDS is more rapid in individuals with high stress - Risk factors for Cardiovascular Disease (Hypertension and Coronary Heart Disease) o Chronic and acute stress o Depression o Anxiety o Type A personality o Lack of resources - Treatment of Stress Related Physical Disorders o Prevention and stress management o Biological interventions  Surgery  Medication • Lipid lowering meds, aspirin, other anticoagulants  Antidepressants o Psychological interventions  Emotional disclosure • Journal venting o Find negative and positives to be effective  Biofeedback • Muscle tension • HR • People can manipulate these  Relaxation  Cognitive-Behavioral Therapy • Targeting the way people think - Stress in the DSM-5 o Trauma and Stress Related Disorders  PTDS  Acute Stress Disorder  Adjustment Disorder  Other Specified Trauma and Stressor-Related Disorder  Unspecified Trauma and Stressor-Related Disorder  Reactive Attachment Disorder (childhood)  Disinhibited social engagement disorder (childhood) o *Traditionally classified as anxiety disorders but not everyone responds with fear and anxiety so DSM changed it and created its own category - PTSD o Characterized by intrusive memories to a traumatic event, emotional withdrawal, negative cognitions and mood, and heightened autonomic arousal o More common in females because tend to respond with more anxiety and fear o Men tend to respond more with depressed moods o Criteria according to DSM-5  A- • Exposure to actual or threatened death, serious injury, or sexual violence  4 categories of Symptoms: (Must last greater than 1 month, and muss cause distress or impairment in functioning) • B- re-experiencing o Recurrent intrusive distressing recollections o Recurrent distressing dreams (related to trauma) o Dissociative reactions (flashbacks) o Intense psych distress at exposure to trauma linked cues o Physiological reactivity to exposure to cues • C- Avoidance o Efforts to avoid distressing memories, thoughts or feelings about the trauma o Efforts to void external reminders  Activities  People  places • D- Negative Cognitions or Mood o Inability to remember important aspects of the trauma (RARE SYMPTOM) o Exaggerated negative belief or expectations about oneself  “I am bad”, “No one can be trusted” o Distorted cognitions about the cause of consequences of the traumatic event  Blaming oneself or others • E- Arousal o Irritability or outbursts of anger o Reckless or self-destructive behavior o Hyper vigilance  Emotional instability o Exaggerated startle response o Difficulty concentrating o Difficulty falling or staying asleep o When symptoms persist greater than 3 months, can be diagnosed o Prevalence  6.8-8.7% lifetime o Gender ratio  3:1 to 2:1 female to male o Age of Onset varies o Comorbidity  Depression and other anxiety disorders o Course  Chronic, although symptoms can wax and wane o Trauma is not a sufficient cause for a disorder, in other words if a trauma occurs it is not guaranteed that you will be diagnosed with PTSD  However, trauma is a NECESSARY cause for PTSD, it must occur to be diagnosed - Causal, Risk and Protective Factors for PTSD o Causal Factors- PTSD- In what conditions does trauma lead to PTSD? Is the traumatic event sufficient?  Nature of the stressor  Biological factor • Serotonin-transporter gene. Hippocampus (memory) o Individual risk factors-PTSD  Personality  Comorbidity  Lack of social support o Appraisals-Cognitive Factors- PTSD  Signs of weakness  People will be ashamed o Protective Factors  Good cognitive ability  Good problem solving skills - Treatment of PTSD o Evidence-based Treatments: (More effective than medications)  Cognitive Behavioral Therapy • Relaxation techniques • Exposure therapy o In vivo or imagination o Expose to situations they fear to show them nothing bad is going to happen • Cognitive processing therapy o Medications  Antidepressants (SSRIs) • Effective with Comorbidity - Acute Stress Disorder o Similar to PTSD however it is often less severe in symptoms presentation o The MAIN DIFFERENECE is that it occurs within 4 weeks of the trauma, lasts greater than 3 days and less than 30 days o Beyond 30- diagnosis of PTSD is warranted - Adjustment Disorder o A psychological response to a common stressor (for example, divorce, death, job loss) that results in clinically significant behavioral/emotional symptoms o Symptoms occur within 3 months of the stressor onset o Person must experience more stress than would be expected given the circumstances or must not be able to function as usual (Distress or Dysfunction) o Symptoms often disappear when the stressor ends or when person learns to adapt to the stressor  If symptoms last longer than 6 months, different diagnosis o People going through severe stress that exceeds their coping resources may warrant the diagnosis of adjustment disorder - How we appraise a stressor will affect how stressful it is o Characteristics of the stressor o Predispositions, etc - Stress can impact not only mental health, but physical health as well - Prevention and stress management is key to avoiding more serious problems Anxiety Disorders - Fear o Basic emotion shared by all animals that involves the activation of the “fight or flight” response of the autonomic nervous system. (Physiologic component) o Cognitive/Subjective o Physiological o Behavioral o Scared, terrified o Strong desire to LEAVE situation o Panic  Fear response in the absence of actual threats (for example, panic attacks) - Anxiety o Complex blend of unpleasant emotions and cognitions that is both more oriented to the future and much more diffuse than fear o Cognitive/Subjective o Physiological o Behavioral o Worry, what-ifs o Desire to AVOID situation o Anxiety can be adaptive- problem occurs when it is excessive - Commonalities of Anxiety Disorders: o Unrealistic, irrational fears and anxieties of disabling intensity o Biological Causes  Personality  Limbic system • Regulates emotion and memory  Neurotransmitters o Psychological causes  Learning  Perceptions of uncontrollability o Comorbidity with other anxiety and mood disorders o Treatment  Exposure therapy (Form of CBT) - Specific Phobias o Characterized by a strong and persistent fear that is triggered by the presence of a specific object or situation o DSM-5 criteria:  Marked fear and anxiety about a specific object or situation  Object almost always evokes immediate fear or anxiety  Avoidance behavior- or endured with extreme anxiety or fear  Fear/anxiety is out of proportion to the actual danger posed and the sociocultural context  Impairment in normal functioning and/or distress  Fear, anxiety, or avoidance is persistent for greater than or equal to 6 months o Subtypes  Animal  Natural environment (heights, water)  Blood injection, Injury  Situational (Tunnels, Elevators)  Other (fear of choking, fear of vomiting) o Lifetime prevalence- 12% o Gender ratio  Varies  90-95% cases of animal type are women  Less than 2:1 ratio for blood injection/injury- pretty much equal o Comorbidity  75%have at least one other specific fear o Age of onset- varies  Animal and blood-injection types- early childhood usually  Others- adolescence or early adulthood o Causal factors  Psychological • Psychodynamic o No empirical support o Believe an unconscious conflict • Behaviorism-Learning o Classical and operant conditioning  Negatively reinforcing anxiety o Vicarious conditioning  Observational o Individual differences o Cognitions  Plays a role in helping maintain disorders o Evolutionary preparedness  Biological • Temperament/ personality • Genetic contribution- some (nonshared environment also VERY important, for example individual experiences) o Treatment  CBT • Number 1 treatment • Exposure therapy o Behavioral technique • Cognitive restructuring during and after exposure  Gradual exposure to feared stimulus, while unpleasant, is not harmful and gradually dissipates  Sometimes effective in one long session (for example 3 hours) • Works fast  Medications • Not very effective o Can interfere with exposure - Social Anxiety Disorder (AKA Social Phobia) o Characterized by disabling fears of one or more specific social situations o Key is fear of negative evaluation o DSM-5 Criteria  Marked fear or anxiety of greater than or equal to 1 social situation in which a person is exposed to unfamiliar people or possible scrutiny of others  Fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated  Social situations provoke anxiety or fear  Avoidance or endured with extreme anxiety or distress  Fear or anxiety is out of proportion to the actual threat posed and to the sociocultural context  Impairment in normal functioning (normal routine, occupational, or social)  Needs to last greater than 6 months o Lifetime prevalence  12% o Gender ratio  3:1 to 2:1 female to male o Comorbidity  >50% have another anxiety disorder in their lifetime  50% experience major depression  33% abuse alcohol  Higher rates of unemployment, and lower, social economic status o Age of onset  Typically mid to late adolescents- early adulthood o Causal Factors  Psychological • Behaviorism- direct and vicarious learning o Can pinpoint specific incident that provoked o 92% report being teases • Evolutionary context? o Dominance hierarchies  Social rankings we have in society • Top=aggressive  Become submissive to dominant figure  Bias to angry • Threatening to us • Perceptions of uncontrollability and unpredictability o Social defeat? o Giving up • Cognitive bias o Expect others will reject or negatively evaluate them  Biological • Temperament/personality o Showing more neurotic traits • Genetic contribution- o Some however most is from nonshared environmental factors o Treatments  CBT- Exactly the same as specific phobia • Exposure therapy- most important • Cognitive restructuring o Identify automatic thoughts  I will make a fool of myself  Then challenge that o Examine evidence for and against such a thought o Videotape feedback • Medication o Antidepressants - Panic Disorder o Characterized by panic attacks that “come out of the blue” and fears of having additional panic attacks o No external stimulus o “the fear of fear” o Panic attack  An abrupt surge of intense fear or discomfort in which 4 of the following symptoms develop abruptly and reaches a peak within minutes • Palpitations of pounding heart • Sweating • Trembling of shaking • Feelings of choking • Chest pain or discomfort • Nausea or abdominal distress • Feeling dizzy, lightheaded, or faint • Chills or heat sensations • Derealization or depersonalization • *fear of losing control of going crazy • *fear of dying • Numbness or tingling sensations o DSM-5 criteria  Recurrent unexpected panic attacks followed by at least 1 month of • Concern about having another one, or worry about the consequences of an attack • Significant maladaptive change in behavior related to attacks (for example designed to avoid panic attacks)  Panic attacks not due to medical condition or physiological response of a substance  Panic attacks not better explained by another mental disorder (usually other anxiety disorders) - Agoraphobia o Characterized by fear and avoidance of public places in which ESCAPE would be physically difficult or embarrassing, or in which immediate help would be unavailable if something bad happened o For example, elevators, empty parking lots, bridges o DSM-5 Criteria  Marked fear or anxiety about 2 or more • Using public transportation • Being in open spaces • Being in enclosed spaces • Standing in line or being in a crowd • Being outside of the home alone  Fears or avoids these situations because escape might be difficult/embarrassing, or in which help may not be available in the event of a panic-like symptoms or other incapacitating or embarrassing symptoms  Situations almost always provoke fear or anxiety  Situations are avoided or endured with distress, or require the presence of a companion  Out of proportion to actual danger, and lasting greater than or equal to 6 months  Not better accounted for by another anxiety disorder or medical conditions - Panic Disorder (irrespective of agoraphobia) o Lifetime prevalence- 4.7% o Gender ratio- 2:1 female to male o Comorbidity- As high as 83% will experience at least one other disorder o Other anxiety disorders, substance use disorders o 50-70% experience major depression o Age of Onset:- early adulthood, not uncommon for women30-40s o Course- chronic and often disabling  But symptoms can wax and wan - Panic Disorders- Causal Factors o Biological  Genetic influence- moderate • But is it specific to panic disorder?  Increased activity at the amygdala (structure in the brain) and other fear networks in the brain  Noradrenergic and serotonergic sys tems in the brain • Systems that affect the cardiovascular systems o Psychological  Comprehensive theory of Learning • Interoceptive conditioning o Internal body sensations of anxiety or arousal (for example increased heart rate) become conditioned stimuli • Exteroceptive conditioning o Associated with agoraphobia • Panic attacks are also likely to become conditioned to internal sensations • Cognitive theory o Perceived threat apprehension or worry  body sensations interpretation of sensations as catastrophic • Anxiety sensitivity • Perceived control • Safety behaviors • Cognitive bias that maintain • (read ch6 pages 186-187) - Panic Disorder and Agoraphobia- Treatment o Medications  Benzodiazephines (xanax, klonopin)  Antidepressants (tricyclics and ssris) o CBT  Introceptive exposure • Targets panic attacks  Exposure to external stimuli • Targets agoraphobia  Cognitive restructuring - Generalized Anxiety Disorder o Characterized by excessive and unreasonable anxiety or worry about many different aspects of life o Uneasiness about life o Continuously upset and discouraged o DSM-5 Criteria:  Excessive anxiety and worry occurring most days for at least 6 months about several thingd  Difficulty controlling the worry  3+symptoms for most days than not • Restlessness or feeling keyed up • Being easily fatigued o Mentally and physically drained because of constant worrying • Difficulty concentrating • Irritability • Muscle tension • Sleep disturbance  Anxiety/ worry not confined to features of another mental disorder, or due to substances or other medical condition • Chronic marijuana use can lead to GAD symptoms so must rule out  Clinically significant distress or impairment in functioning o Prevalence  3% in any 1 year period  5.7% lifetime o Course  Tends to be chronic o Gender difference  2:1 ratio female to male o Age of onset  Varies o Comorbidity  Often co-occurs with other anxiety or mood disorders o Causal Factors  Psychological • Perceptions of uncontrollability and unpredictability o Uncertainty becomes a big factor in this disorder • The role of worry o Belief that worry is a good thing  Believes it helps them avoid catastrophes  Distracts them from other negative emotions o Worry (cognitive) reduces physiologic symptoms  Prepares them for negative events o However, it increases the sense of danger and anxiety  Tend to be hyper vigilant to things in their environment • Cognitive biases for threat  Biological • Genetics o Some heritability  But second lowest to phobia o Common predisposition with depression  Neuroticism? • Neurotransmitter and neurohormonal abnormalities o GABA deficiency o Cortico-tropin releasing hormone o Treatment  Medications • Benzodiazepines o May relieve physical, but not cognitive, symptoms • Antidepressants o Help cognitive symptoms  CBT • Similar to how we treat depressive disorders • Muscle relaxation • Cognitive restructuring o This is why it takes longer to treat - Obsessive-Compulsive and Related Disorders o OCD  Moved out of anxiety disorders o Hoarding Disorder o Body Dysmorphic Disorder  Used to be with OCD, now on its own o Trichotillomania (hair-pulling) o Excoriation (Skin-picking) disorder - OCD o Characterized by the reoccurrence of unwanted and intrusive obsessive thoughts or distressing images; often accompanied by compulsive behaviors to cope with such thoughts o DSM-5 Criteria  Presence of obsessions or compulsions, or both • Don’t need both, can be one or the other  Marked distress, time consuming, or interference with functioning • 4 or 5 hours engaging in ritualistic behaviors  Not attributable to physiological effects of a substance or other medical condition  Not better explained by the symptoms of another mental disorder o Obsessions are defined by  Recurrent and persistent thoughts, impulses or images that are intrusive and unwanted and in most individuals cause marked anxiety or distress  Attempts to ignore, suppress, or neutralize them with some other thought or action (often compulsions)  Common examples • Contamination fears • Fears of harming oneself or others • Pathological doubt • Need for symmetry • Sexual obsessions • Religious obsessions o Compulsions are defined by
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